This JAMA Insights Clinical Update discusses the underrecognition of delirium in older adults with COVID-19 and provides delirium prevention strategies for hospitalized patients, such as providing ...remote visits with family members and therapeutic activity kits to the bedside.
Delirium in Older Persons Inouye, Sharon K
The New England journal of medicine,
03/2006, Letnik:
354, Številka:
11
Journal Article
Recenzirano
Odprti dostop
The prevalence of delirium increases sharply with age, and about 20 percent of older patients have delirium at the time of hospital admission for any reason. This review summarizes the clinical ...manifestations of and risk factors for delirium and the evaluation of patients with this condition. It includes an update on the current understanding of the pathogenesis of delirium and provides guidance regarding practical measures to prevent this common complication.
This review summarizes the clinical manifestations of and risk factors for delirium and the evaluation of patients with this condition. It includes an update on the current understanding of the pathogenesis of delirium and provides guidance regarding practical measures to prevent this common complication.
Delirium, an acute decline in attention and cognition, is a common, life-threatening, and potentially preventable clinical syndrome among persons who are 65 years of age or older. The development of delirium often initiates a cascade of events culminating in the loss of independence, an increased risk of morbidity and mortality, and increased health care costs.
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Delirium in hospitalized older patients has assumed particular importance because the care of such patients accounts for more than 49 percent of all hospital days.
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Delirium complicates hospital stays for at least 20 percent of the 12.5 million patients 65 years of age or . . .
Summary Delirium and dementia are two of the most common causes of cognitive impairment in older populations, yet their interrelation remains poorly understood. Previous studies have shown that ...dementia is the leading risk factor for delirium and that delirium is an independent risk factor for subsequent development of dementia. However, a major area of controversy is whether delirium is simply a marker of vulnerability to dementia, whether the effect of delirium is solely related to its precipitating factors, or whether delirium itself can cause permanent neuronal damage and lead to dementia. Ultimately, all of these hypotheses are likely to be true. Emerging evidence from epidemiological, clinicopathological, neuroimaging, biomarker, and experimental studies lends support to a strong relation between delirium and dementia, and to both shared and distinct pathological mechanisms. New preventive and therapeutic approaches that target delirium might offer a sought-after opportunity for early intervention, preservation of cognitive reserve, and prevention of irreversible cognitive decline in ageing.
Objectives
To evaluate the effectiveness of antipsychotic medications in preventing and treating delirium.
Design
Systematic review and meta‐analysis.
Setting
PubMed, EMBASE, CINAHL, and ...ClinicalTrials.gov databases were searched from January 1, 1988, to November 26, 2013.
Participants
Adult surgical and medical inpatients.
Intervention
Antipsychotic administration for delirium prevention or treatment in randomized controlled trials or cohort studies.
Measurements
Two authors independently reviewed all citations, extracted relevant data, and assessed studies for potential bias. Heterogeneity was considered as chi‐square P < .1 or I2 > 50%. Using a random‐effects model (I2 > 50%) or a fixed‐effects model (I2 < 50%), odds ratios (ORs) were calculated for dichotomous outcomes (delirium incidence and mortality), and mean or standardized mean difference for continuous outcomes (delirium duration, severity, hospital and intensive care unit (ICU) length of stay (LOS)). Sensitivity analyses included postoperative prevention studies only, exclusion of studies with high risk of bias, and typical versus atypical antipsychotics.
Results
Screening of 10,877 eligible records identified 19 studies. In seven studies comparing antipsychotics with placebo or no treatment for delirium prevention after surgery, there was no significant effect on delirium incidence (OR = 0.56, 95% confidence interval (CI) = 0.23–1.34, I2 = 93%). Using data reported from all 19 studies, antipsychotic use was not associated with change in delirium duration, severity, or hospital or ICU LOS, with high heterogeneity among studies. No association with mortality was detected (OR = 0.90, 95% CI = 0.62–1.29, I2 = 0%).
Conclusion
Current evidence does not support the use of antipsychotics for prevention or treatment of delirium. Additional methodologically rigorous studies using standardized outcome measures are needed.
Although a number of studies have documented the negative clinical and economic consequences of delirium, interventions to prevent and treat delirium are infrequently implemented. The importance of ...delirium may continue to be underestimated until its societal and economic effects are documented. The current article outlines the existing literature related to long‐term sequelae and costs associated with delirium and stresses the importance of such research in prompting recognition, prevention, and treatment efforts that could reduce the effect of delirium and improve quality of life for older adults and their caregivers.
Delirium in elderly people Inouye, Sharon K, Dr Prof; Westendorp, Rudi GJ, Prof; Saczynski, Jane S, PhD
The Lancet (British edition),
03/2014, Letnik:
383, Številka:
9920
Journal Article
Recenzirano
Odprti dostop
Summary Delirium is an acute disorder of attention and cognition in elderly people (ie, those aged 65 years or older) that is common, serious, costly, under-recognised, and often fatal. A formal ...cognitive assessment and history of acute onset of symptoms are necessary for diagnosis. In view of the complex multifactorial causes of delirium, multicomponent non-pharmacological risk factor approaches are the most effective strategy for prevention. No convincing evidence shows that pharmacological prevention or treatment is effective. Drug reduction for sedation and analgesia and non-pharmacological approaches are recommended. Delirium offers opportunities to elucidate brain pathophysiology—it serves both as a marker of brain vulnerability with decreased reserve and as a potential mechanism for permanent cognitive damage. As a potent indicator of patients' safety, delirium provides a target for system-wide process improvements. Public health priorities include improvements in coding, reimbursement from insurers, and research funding, and widespread education for clinicians and the public about the importance of delirium.
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